Healthcare Provider Details

I. General information

NPI: 1205168184
Provider Name (Legal Business Name): PACIFIC EYECARE & OPTICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 W LOWELL AVE SUITE 120
SPOKANE WA
99208-8587
US

IV. Provider business mailing address

5208 E WHITEHALL LN
COLBERT WA
99005-9165
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-0215
  • Fax:
Mailing address:
  • Phone: 509-844-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOD3853
License Number StateWA

VIII. Authorized Official

Name: DR. THOMAS A MYERS
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 509-844-8184